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Immediate adenoidectomy vs initial watchful waiting strategy in children with recurrent upper respiratory tract
Chantal W B Boonacker1, Maaike T A van den Aardweg, Pieter H Broos
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. c.w.b.boonacker@umcutrecht.nl
Insights
Immediate adenoidectomy for recurrent upper respiratory tract infections (URTIs) in children increases costs without providing clinical benefits compared to watchful waiting. This strategy is more expensive and offers no significant advantage.
Area of Science:
- Otolaryngology
- Pediatric Health Economics
Background:
- Recurrent upper respiratory tract infections (URTIs) are common in children.
- Adenoidectomy is a common surgical intervention for recurrent URTIs.
- The cost-effectiveness of immediate adenoidectomy versus watchful waiting requires evaluation.
Purpose of the Study:
- To compare the economic costs of two clinical strategies for children with recurrent URTIs.
- To evaluate immediate adenoidectomy against an initial watchful waiting approach.
Main Methods:
- A cost-minimization analysis was conducted from a societal perspective.
- Included direct and indirect costs over a 2-year follow-up period.
- An open randomized controlled trial involving 111 children (aged 1-6 years) across multiple Dutch hospitals was performed.
Main Results:
- The median total costs were €1385 for immediate adenoidectomy and €844 for watchful waiting.
- Increased costs in the adenoidectomy group were mainly due to surgery and specialist visits.
- No significant differences in other cost categories were observed between the groups.
Conclusions:
- Immediate adenoidectomy for recurrent URTIs in children incurs higher costs.
- The surgical approach offers no demonstrable clinical benefit over watchful waiting.
- Watchful waiting may be a more cost-effective strategy for selected children.
Objective:
To compare the costs associated with 2 clinical strategies in children with recurrent upper respiratory tract infections (URTIs): immediate adenoidectomy vs an initial watchful waiting strategy.
Design:
A cost-minimization analysis from a societal perspective including both direct and indirect costs, alongside an open randomized controlled trial with a 2-year follow-up.
Setting:
Multicenter study, including 11 general and 2 university hospitals in the Netherlands.
Patients:
The study population comprised 111 children aged 1 through 6 years, selected for adenoidectomy for recurrent URTIs according to current clinical practice.
Intervention:
A strategy of immediate adenoidectomy with or without myringotomy or a strategy of initial watchful waiting.
Main Outcomes Measures:
Difference in median costs during the 2-year follow-up.
Results:
The median total of direct and indirect costs in the adenoidectomy and watchful waiting group were €1385 (US $1995) and €844 (US $1216) per patient, respectively. The extra costs in the adenoidectomy group are primarily attributable to surgery and visits to the otorhinolaryngologist. Other costs did not differ significantly between the groups.
Conclusions:
In children selected for adenoidectomy for recurrent URTIs, immediate adenoidectomy results in an increase in costs, whereas it confers no clinical benefit over an initial watchful waiting strategy.
Trial Registration:
trialregister.nl Identifier:NTR968; isrctn.org Identifier:ISRCTN03720485.
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